Provider Demographics
NPI:1265866578
Name:BOON, KIM (LMSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BOON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12-19 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1843
Mailing Address - Country:US
Mailing Address - Phone:201-703-4371
Mailing Address - Fax:201-703-4376
Practice Address - Street 1:12-19 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1843
Practice Address - Country:US
Practice Address - Phone:201-703-4371
Practice Address - Fax:201-703-4376
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL04838900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker